Transforming a School Based Health Center into a Patient Centered Medical Home
|
|
- Ronald West
- 5 years ago
- Views:
Transcription
1 Transforming a School Based Health Center into a Patient Centered Medical Home April 14, :15 11:0 am Eugene F. Sun, MD, MBA Chief Medical Officer Molina Healthcare of New Mexico
2 Outline Molina Healthcare of New Mexico Primary Care in New Mexico Coordination of Care School Based Health Centers (SBHCs) Patient Centered Medical Homes (PCMHs) SBHCs as PCMHs Molina approach to PCMH Conclusion 2
3 Molina Healthcare of New Mexico Manages the healthcare needs of approximately 210,000 New Mexicans covered under government programs People younger than 21 are a majority of the members we insure NCQA Excellent Accreditation Emphasis on helping people navigate the complex healthcare system #1 in Top 10 Hispanic Health Care Organizations
4 Primary Care Providers In the United States the PCP to specialist ratio is about 0:70 2 In other developed countries the ratio is 70:0 In those countries health care costs are lower and outcomes often better In New Mexico the ratio is about 20:80 Currently about 7% of medical students enter office based primary care 2. Klepper, B., Medscape Journal of Medicine. 2008; 10(12): 280 PMCID:
5 Coordination of Care Provide efficient and effective care at any given time in illness or wellness Establish and guide patient and family expectations Manage care proactively at all times and all settings, matching appropriate resources to the patient s condition Optimize resource utilization: family, community, and provider resources
6 Coordination of Care Enable patients and their families to become active, informed partners in their healthcare Focus on prevention and wellness Improve overall healthcare delivery
7 School Based Health Centers Are located in schools or on school grounds. Work cooperatively within the school to become an integral part of the school. Provide a comprehensive range of services that meet the specific physical and behavioral health needs of the young people in the community. Employ a multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, and other health professionals. Source: National Assembly on School-Based Health Care
8 School Based Health Centers Provide clinical services through a qualified health provider such as a hospital, health department, or medical practice. Require parents to sign written consents for their children to receive the full scope of services provided at the SBHC. Have an advisory board consisting of community representatives, parents, youth, and family organizations, to provide planning and oversight.
9 School Based Health Centers Principles 1. Supports the School 2. Responds to the Community. Focuses on the Student 4. Delivers Comprehensive Care 5. Advances Health Promotion Activities 6. Implements Effective Systems 7. Provides Leadership in Adolescent and Child Health
10 The Patient-Centered Medical Home Defined ACP, AAFP, AAP, AOA Joint Principles April 2007 Personal physician each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. Physician directed medical practice the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. Whole person orientation the personal physician is responsible for providing for all the patient s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
11 School Based Health Centers as Patient Centered Medical Homes School Based Health Centers Patient Centered Medical Homes Provide a comprehensive range of services that meet the specific physical and behavioral health needs of the young people Multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, and other health professionals Provide clinical services through a qualified health provider such as a hospital, health department, or medical practice. Provide for all the patient s health care needs or taking responsibility for appropriately arranging care with other qualified professionals Team of individuals at the practice level who collectively take responsibility for the ongoing care of patients Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient s community (e.g., family, public and private community-based services).
12 NCQA Standards PPC 1: Access and communication PPC 2: Patient tracking and registry functions PPC : Care management PPC 4: Patient self-management support PPC 5: Electronic prescribing PPC 6: Test tracking PPC 7: Referral tracking PPC 8: Performance reporting and improvement PPC 9: Advanced electronic communications
13 Standard 1: Access and Communication A. Has written standards for patient access and patient communication** B. Uses data to show it meets its standards for patient access and comunication** Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly non-clinical data) B. Has clinical data system with clinical data in searchable data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to organize clinical information** E. Uses data to identify important diagnoses and conditions in practice** F. Generates lists of patients and reminds patients and clinicians of services needed (population management) Standard : Care Management A. Adopts and implements evidence-based guidelines for three conditions ** B. Generates reminders about preventive services for clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans, assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive care in inpatient and outpatient facilities Standard 4: Patient Self-Management Support A. Assesses language preference and other communication barriers B. Actively supports patient self-management** Pts Pts Pts Pts Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checks C. Has electronic prescription writer with cost checks Standard 6: Test Tracking A. Tracks tests and identifies abnormal results systematically** B. Uses electronic systems to order and retrieve tests and flag duplicate tests Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic system** Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by physician or across the practice** B. Survey of patients care experience C. Reports performance across the practice or by physician ** D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures electronically to external entities Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support Pts 2 8 Pts PT 4 4 Pts Pts **Must Pass Elements
14 PPC-PCMH Scoring Level of Qualifying Points Must Pass Elements at 50% Performance Level Level of 10 Level of 10 Level of 10 Not Recognized 0 24 < 5 Levels: If there is a difference in Level achieved between the number of points and Must Pass, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 Must Pass Elements, the practice will achieve at Level 1. Practices with a numeric score of 0 to 24 points or less than 5 Must Pass Elements are not Recognized.
15 Community Care of North Carolina Goal: Reduce Medicaid costs and improve the health of the patient population Setting: Local partnerships of physicians, hospitals, health departments, and departments of social services Changes: > After-hours pediatric clinic (6 PM to 10 PM)/65 nights/year > Nurse advice phone line > 1 Case Manager per,00/pts, averaging 100 to 200 patients at any given time > Developed disease management tools > Case management fee 1. Wilson CF. Community care of North Carolina: Saving state money and improving patient care. NC Med J. 2005; 66():229-.
16 Community Care of North Carolina Outcomes > 17% decrease in Emergency Department visits by Medicaid patients under age 21 in 1st year (1999) 1 Parents and patients appreciated the convenience of Emergency Department alternatives > 17% decline in Emergency Department admissions 200 to 2006 despite 176% increase in number of patients diagnosed with asthma 2 > Opportunities for improvement drive change Practice-specific data identifies opportunities 1. Wilson CF. Community care of North Carolina: Saving state money and improving patient care. NC Med J. 2005; 66(): Asthma Disease Management Program Summary. Community Care of North Carolina, Available at:
17 Molina s Approach to PCMHs Invite PCP groups to obtain NCQA PCMH accreditation Subsidize application fee Provide consultative support during process Once accreditation achieved provide quarterly incentive payments based on assigned MHNM membership Develop outcomes measures Measure and report on success of program
18 Molina s Approach to PCMHs Subsidize 50% of application fee for the group at the outset Once accreditation is achieved reimburse an additional 25% to the group Help groups develop and incorporate components of Medical Home into their work processes Pay quarterly incentives for first year Develop -5 Outcomes measures for subsequent incentives Update incentives to achieve desired Outcomes
19 How to Transform SBHC s into PCMH s? NCQA Accreditation Reimbursement model Outcomes measures Patient (and parent) satisfaction Others?
20 Discussion
Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH ) Johann Chanin
Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH ) Johann Chanin Colorado Patient-Centered Medical Home Demonstration Project Meeting January 15, 008 Today NCQA quality measurement
More informationPrescription for Pennsylvania The Pennsylvania Multi-Payer Statewide Medical Home Model
Prescription for Pennsylvania The Pennsylvania Multi-Payer Statewide Medical Home Model Robert Gabbay MD, PhD Director, Penn State Institute for Diabetes and Obesity Professor of Medicine Penn State College
More informationAdirondack Medical Home Pilot Overview. Dennis Weaver MD MBA November 2, 2010
Adirondack Medical Home Pilot Overview Dennis Weaver MD MBA November 2, 2010 Critical Success Factors Lessons Learned Partnership among all stakeholders is essential Must define common goals and timelines
More informationWHAT IT FEELS LIKE
PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards
More informationAPPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS
Appendix 2 NCQA PCMH 2011 and CMS Stage 1 Meaningful Use Requirements 2-1 APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS CMS Meaningful Use Requirements* All Providers Must Meet
More informationAbout the National Standards for CYSHCN
National Standards for Systems of Care for Children and Youth with Special Health Care Needs: Crosswalk to National Committee for Quality Assurance Primary Care Medical Home Recognition Standards Kate
More informationPatient Centered Medical Home The next generation in patient care
Patient Centered Medical Home The next generation in patient care Provider Training Module I OBJECTIVE To explain... What Patient Centered Medical Home is How it works Why it s important Where to begin
More informationPatient-Centered Medical Home: What Is It and How Do SBHCs Fit In?
Patient-Centered Medical Home: What Is It and How Do SBHCs Fit In? Sue Sirlin, CPEHR Director, HIT Consulting Services Bonni Brownlee, MHA CPHQ CPEHR Principal Consultant March 15, 2013 Advancing Healthcare
More informationAAFP Talking Points: Patient Centered Medical Home
November 2007 Patient Centered Medical Home What is a patient centered (or personal) medical home? The patient centered medical home model is based on the premise that the best health care is not episodic
More informationPatient Centered Medical Home 2011
Patient Centered Medical Home 2011 NCQA Standards Rand David, MD, FACP Associate Professor of Medicine Director, Dept. of Ambulatory Care Mount Sinai School of Medicine Elmhurst Hospital Center I have
More informationPatient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)?
What is a Patient Centered Medical Home (PCMH)? Patient Centered Medical Home Jeremy Thomas, PharmD, CDE UAMS Department of Pharmacy "an approach to providing comprehensive primary care that facilitates
More informationRussell B Leftwich, MD
Russell B Leftwich, MD Chief Medical Informatics Officer Office of ehealth Initiatives, State of Tennessee 1 Eligible providers and hospitals can receive incentives for meaningful use of certified EHR
More informationMedical Assistance Program Oversight Council. January 10, 2014
Medical Assistance Program Oversight Council January 10, 2014 Presentation Outline Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Evolution of the Concept of Patient-Centered Medical Home A New Model of HealthCare Delivery PCMH
More informationMEDICAL HOME Implementation for Primary Care. Disclosure. Medical Home Building and Implementation for Primary Care: No Child Left Behind
Medical Home Building and Implementation for Primary Care: No Child Left Behind A. Chris Olson, MD, MHPA Clinical Professor, University of Washington Medical Director, Sacred Heart Children s Hosp. Providence
More informationMoving Toward Recognition: Understanding Patient-Centered Medical Home (PCMH) and the NCQA PCMH 2011 Standards
Moving Toward Recognition: Understanding Patient-Centered Medical Home (PCMH) and the NCQA PCMH 2011 Standards Presented by Lori-Anne Russo, Director of Clinical Programs to the PCMH Learning Collaborative
More informationPractice Transformation: Patient Centered Medical Home Overview
Practice Transformation: Patient Centered Medical Home Overview Megan A. Housley, MBA Business Development Director Kentucky Regional Extension Center The Triple Aim Population Health TRIPLE AIM Per Capita
More informationNCQA s Patient-Centered Medical Home (PCMH) 2011
NCQA s Patient-Centered Medical Home (PCMH) 2011 Johann Chanin, Director, Product Development Mina Harkins, Assistant Vice President, Recognition Programs All materials 2011, National Committee for Quality
More informationPatient Centered Medical Home (PCMH)
Patient Centered Medical Home (PCMH) The PCMH is a model of practice in which a Team of health professionals, guided by a personal physician, provides continuous, comprehensive, and coordinated care in
More informationPatient Centered Medical Home Foundation for Accountable Care
Patient Centered Medical Home Foundation for Accountable Care Outline of Presentation History and tenants of the patient-centered care and PCMH model Defining, measuring, recognizing, and evaluating the
More informationAppendix 5. PCSP PCMH 2014 Crosswalk
Appendix 5 Crosswalk NCQA Patient-Centered Medical Home 2014 July 28, 2014 Appendix 5 Crosswalk 5-1 APPENDIX 5 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice () standards with
More informationThe Medical Home Model as a Solution to Diabetes Disparities
Kenyatta Lee, MD Clinical Director Community Clinics Department University of Florida/Shands Jacksonville The Medical Home Model as a Solution to Diabetes Disparities Objectives: 1Provide an overview the
More informationPatient Centered Medical Home: Transforming Primary Care in Massachusetts
Patient Centered Medical Home: Transforming Primary Care in Massachusetts Judith Steinberg, MD, MPH Deputy Chief Medical Officer Commonwealth Medicine UMass Medical School Agenda Overview of Patient Centered
More informationIntegration Workgroup: Bi-Directional Integration Behavioral Health Settings
The Accountable Community for Health of King County Integration Workgroup: Bi-Directional Integration Behavioral Health Settings May 7, 2018 1 Integrated Whole Person Care in Community Behavioral Health
More informationTX Action Learning Collaborative: National Standards for Systems of Care for CYSHCN
TX Action Learning Collaborative: National Standards for Systems of Care for CYSHCN January 21, 2015. Children s Policy Council 1 http://www.amchp.org/aboutamchp/newsletters/member-briefs/documents/standards%20charts%20final.pdf
More informationPCSP 2016 PCMH 2014 Crosswalk
- Crosswalk 1 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice (PCSP) 2016 standards with NCQA s Patient-Centered Medical Home (PCMH) 2014 standards. The column on the right identifies
More informationPutting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018
Putting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018 WEBINAR FACILITATOR Hannah Stanfield NCQA PCMH CCE Practice Transformation Coordinator WACMHC
More informationHudson Headwaters Journey to Patient Centered Medical Home Recognition
Hudson Headwaters Journey to Patient Centered Medical Home Recognition Cyndi Nassivera-Cordes, VP Clinical Quality February 9, 2012 R4 1 Initial Steps Identify PCMH Project Leader Educate Yourself Determine
More informationGonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group
Gonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group Describe the main characteristics of a PCMH Analyze potential benefits of becoming a PCMH Examine the criteria
More informationThe Patient Centered Medical Home: 2011 Status and Needs Study
The Patient Centered Medical Home: 2011 Status and Needs Study Reestablishing Primary Care in an Evolving Healthcare Marketplace REPORT COVER (This is the cover page so we need to use the cover Debbie
More informationPCMH 2014 Recognition Checklist
1 PCMH1: Patient Centered Access 10.00 points Element A - Patient-Centered Appointment Access ~~ MUST PASS 4.50 points 1 Providing same-day appointments for routine and urgent care (Critical Factor) Policy
More informationAppendix 4 CMS Stage 1 Meaningful Use Requirements Summary Tables 4-1 APPENDIX 4 CMS STAGE 1 MEANINGFUL USE REQUIREMENTS SUMMARY
Appendix 4 CMS Stage 1 Meaningful Use Requirements Summary Tables 4-1 APPENDIX 4 CMS STAGE 1 MEANINGFUL USE REQUIREMENTS SUMMARY 1. Use CPOE (computerized physician order entry) for medication orders directly
More informationCROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS
CROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS 1a. Provide visible and sustained leadership to lead overall cultural change as well as specific strategies
More informationThe Patient Centered Medical Home Guidelines: A Tool to Compare National Programs
The Patient Centered Medical Home Guidelines: A Tool to Compare National Programs Medical Group Management Association (MGMA ) publications are intended to provide current and accurate information and
More informationPCC Resources For PCMH. Tim Proctor Users Conference 2017
PCC Resources For PCMH Tim Proctor (tim@pcc.com) Users Conference 2017 Agenda Current state of PCMH and what s coming Exploration of how PCC functionality applies to new 2017 PCMH factors PCC Resources
More informationNCQA s Patient-Centered Medical Home Recognition and Beyond. Tricia Marine Barrett, VP Product Development
NCQA s Patient-Centered Medical Home Recognition and Beyond Tricia Marine Barrett, VP Product Development National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality
More informationPatient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP)
Patient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP) Foundation for a Better Health Care System Presenter Jeanette Ikan, M.D., MHAI Objectives: Definition and benefits of PCMH,
More informationTopic 3B: Documentation Prep for NCQA Recognition Focus on Standards 3, 4, and 1F
Topic 3B: Documentation Prep for NCQA Recognition Focus on Standards 3, 4, and 1F Diane Altman Dautoff, MSW, EdD, Senior Consultant Heather Russo, Consultant January 2013 Welcome Introductions and Housekeeping
More informationQUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:
QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care
More informationFebruary 2007 ACP, AAFP, AAP, AOA joint statement
Patient Centered Medical Home in a Safety Net Community Health Clinic: The T Transformation f i off Eastside Adult Clinic Nicole Joseph, MD Denver Health GIM Grand G dr Rounds d February 7, 2012 OBJECTIVES
More informationClinician Information Packet: Transition from Pediatric to Adult Care
Clinician Information Packet: Transition from Pediatric to Adult Care 1 This packet contains information about: Processes for planning, transferring and integrating patients into adult care How to incorporate
More informationPCC Resources For PCMH
PCC Resources For PCMH Tim Proctor Users Conference 2015 Goals and Takeaways Introduction to NCQA's 2014 PCMH. What is it? Why get recognition? Show how PCC functionality and reports can be used for PCMH
More informationBuilding a Better Home: Transformation to a Patient Centered Health Home. Anna M. Gard, FNP-BC Association of Clinicians for the Underserved
Building a Better Home: Transformation to a Patient Centered Health Home Anna M. Gard, FNP-BC Association of Clinicians for the Underserved A Patient Centered Health Home is not a place but an approach
More informationNCQA PCMH 2017 Standard Two 4/11/18. 6 PCMH Concepts within the standards
Candace Chitty RN, MBA, CPHQ, PCMH-CCE 1 6 PCMH Concepts within the standards 1. Team-Based Care and Practice Organization (TC). 2. Knowing and Managing Your Patients (KM). 3. Patient-Centered Access and
More informationINTEGRATION AND COORDINATION OF BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE
THE CENTER FOR POLICY, ADVOCACY, AND EDUCATION OF THE MENTAL HEALTH ASSOCIATION OF NEW YORK CITY INTEGRATION AND COORDINATION OF BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE A Presentation at The Community
More informationFebruary February
February 2 2016 February PCMH TRANSFORMATION PCMH KEY COMPONENTS* Personal Clinician: first contact, continuous, comprehensive, care team Whole Person Orientation: all patient health care needs, all stages
More informationPatient-Centered Medical Home (PCMH) Transformation and Recognition/Certification Programs
Patient-Centered Medical Home (PCMH) Transformation and Recognition/Certification Programs Ruth S. Gubernick, PhDc, MPH, PCMH CCE For the NJAAP s Systems Integration Medical Home Project October 27, 2016
More informationDeep Dive on the Must Pass NCQA PCMH Requirements & Standards
PATIENT CENTERED MEDICAL HOME & MEANINGFUL USE COLLABORATIVE Kick Off Session July 21, 2010 Deep Dive on the Must Pass NCQA PCMH Requirements & Standards Presentation by: Deborah Johnson Ingram What is
More information2014 PCMH STANDARDS. Renewals & Annual Data Requirements
2014 PCMH STANDARDS Renewals & Annual Data Requirements PCMH Renewal Process Streamlined process for renewal through reduced documentation requirements. Even though some elements do not require documentation,
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationCare Management in the Patient Centered Medical Home. Self Study Module
Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management
More informationTips for PCMH Application Submission
Tips for PCMH Application Submission Remain calm. The certification process is not as complicated as it looks. You will probably find you are already doing many of the required processes, and these are
More information2014 Patient Centered Medical Home (PCMH) Recognition
Collaboration Catalyst Community 2014 Patient Centered Medical Home (PCMH) Recognition PRESENTED BY: Oct. 2015 RuthAnn Craven, MS Transformation Coach AHI is an independent, nonprofit organization that
More informationPresbyterian Healthcare Services Care Management
Presbyterian Healthcare Services Care Management Kathy M. Garcia RN, BSN Director of Nursing, Primary Care Service Line November 2012 Future Healthcare Challenges Increasing number of patients Decreasing
More informationOhio Department of Medicaid
Ohio Department of Medicaid Joint Medicaid Oversight Committee March 19, 2015 John McCarthy, Medicaid Director 1 Payment Reform Care Management Quality Strategy Today s Topics Managed Care Performance
More informationPatient-Centered Connected Care 2015 Recognition Program Overview. All materials 2016, National Committee for Quality Assurance
Patient-Centered Connected Care 2015 Recognition Program Overview All materials 2016, National Committee for Quality Assurance Learning Objectives Introduction to Patient-Centered Connected Care and Eligibility
More informationBCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor
BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines 2016-2017 V11.0 Blue Cross Blue Shield of Michigan is a nonprofit
More informationPart 3: NCQA PCMH 2014 Standards
Part 3: NCQA PCMH 2014 Standards Heather Russo, CCE PCMH Consultant September 15, 2015 Advancing Healthcare Improving Health PCMH Standard 4: Care What s New? Management and Support Combined 2011 Standards
More informationCHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE
CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE TABLE OF CONTENTS What is Chronic Care Management (CCM)?... 2 Why CCM?... 2 Clinician/Practice Benefits... 3 Patient Benefits... 4 What is Included in CCM?...
More informationPatient-Centered Specialty Practice (PCSP) Recognition Program
Patient-Centered Specialty Practice (PCSP) Recognition Program Standards Workshop Part 2 2013 All materials 2013, National Committee for Quality Assurance Agenda Part 1 Content of PCSP Standards and Guidelines
More informationENGAGED LEADERSHIP. TC-02 (Core): Defines practice organizations structure and staff responsibilities/skills to support key PCMH functions.
Change Concepts for Practice Transformation AND 2014 NCQA PCMH Standards Crosswalk to 2017 NCQA Standards Change Concept Element 2014 NCQA PCMH Standards 2014 --> 2017 2017 NCQA Standards ENGAGED LEADERSHIP
More informationCare Coordination Overview. Janet Tennison, PhD UPV Standards October 8, 2013
Care Coordination Overview Janet Tennison, PhD UPV Standards October 8, 2013 What IS Care Coordination? The deliberate, proactive organization of patient care activities between two or more participants
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationTransitions of Care: Primary Care Perspective. Patrick Noonan, DO
Transitions of Care: Primary Care Perspective Patrick Noonan, DO Disclosures None Bio Outpatient primary care internist at New Pueblo Medicine Completed residency at the University of Iowa Graduated from
More informationGUIDELINES FOR ADVERTISING AND MARKETING RECOGNITION PROGRAMS. Table of Contents
GUIDELINES FOR ADVERTISING AND MARKETING RECOGNITION PROGRAMS Table of Contents INTRODUCTION 2 USE OF RECOGNITION SEALS 2 APPROVED QUOTE 6 RECOMMENDED LANGUAGE 7 PROGRAM-SPECIFIC INFORMATION 8 HEART/STROKE
More informationMcLaren Health Plan Quality Improvement Update 2014
McLaren Health Plan Quality Improvement Update 2014 Since the incorporation of McLaren Health Plan (MHP) in November 1997, the staff has continued to utilize their extensive clinical and administrative
More informationNational Committee for Quality Assurance
National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality oversight organization founded in 1990 MISSION To improve the quality of health care. VISION To transform
More informationNCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11
NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11 28 PCMH 1: Enhance Access and Continuity PCMH 1: Enhance Access and Continuity 20 points provides access to culturally and linguistically
More informationPCMH: Recognition to Impact
PCMH: Recognition to Impact 3.1.16 Prepared by: Shannon Nielson, MHA, PCMH CCE Prepared for: OACHC 2016 Annual Conference Centerprise, Inc Objectives Defining a Patient Centered Medical Home Translating
More informationProviderReport. Managing complex care. Supporting member health.
ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be
More informationOverview. Patient Centered Medical Home. Demonstrations and Pilots: Judith Steinberg, MD, MPH March 6, 2009
Patient Centered Medical Home Judith Steinberg, MD, MPH March 6, 2009 Patient Centered Medical Home Payment Reform & Incentive Alignment Transparency and Measurement Quality Improvement Practice Transformation
More informationEnhancing the Medical Home for Children with Special Health Care Needs: A Quantitative Approach
Enhancing the Medical Home for Children with Special Health Care Needs: A Quantitative Approach The Quality Colloquium August 20, 2008 Angelo P. Giardino, MD, PhD, MPH Renee M. Turchi, MD, MPH Overview
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2017 This document is a guide to the 2017 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationIntroducing AmeriHealth Caritas Iowa
Introducing AmeriHealth Caritas Iowa A presentation for Iowa providers. CPC; Q215 Iowa V1 Who We Are Who We Serve Agenda Our Mission AmeriHealth Caritas Iowa Why Partner With Us? Questions 2 2 Who We Are
More informationAnnual Reporting Requirements for PCMH Recognition Overview & Table Reporting Period: 4/3/2017 3/31/2018
Annual Reporting Requirements for PCMH Recognition Overview & Table Reporting Period: 4/3/2017 3/31/2018 Redesign Goals NCQA is redesigning our PCMH Recognition program. The redesigned program to be launched
More informationRequirements Document for the Blue Quality Physician Program sm Criteria Effective 08/03/2015
All practices must reapply to the BQPP every 18 months Criteria Definition Validation Source(s) 7 Practice Elements 3 Provider Elements Practice level points: 1. PCMH/PPC/PCSP Recognition *Mandatory 2.
More informationPPC2: Patient Tracking and Registry Functions
PPC2: Patient Tracking and Registry Functions Element F: Use of System for Population Management At we use our EMR, clinical event manager, and the ad hoc reporting system (Business Objects) for a multi-pronged
More informationUniversity of Cincinnati Patient Centered Medical Home Leadership Decisions
University of Cincinnati Patient Centered Medical Home Leadership Decisions Eric J. Warm M.D., F.A.C.P. Program Director, Internal Medicine Associate Professor of Medicine University of Cincinnati College
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationUsing Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor
Using Facets of Midas+ Hospital Case Management to Support Transitions of Care Barbara Craig, Midas+ SaaS Advisor What does Transitional Care Include? Transitional Care is the smooth conversion of a patient
More informationCalifornia Academy of Family Physicians Diabetes Initiative Care Model Change Package
California Academy of Family Physicians Diabetes Initiative Care Model Change Package Introduction The Care Model (CM) is a unique and proven approach for implementing proactive strategies that are responsive
More informationQuality Improvement Program
Introduction Molina Healthcare of Michigan serves Michigan members in counties throughout Michigan since 2000. For all plan members, Molina Healthcare emphasizes personalized care that places the physician
More information2.b.iii ED Care Triage for At-Risk Populations
2.b.iii ED Care Triage for At-Risk Populations Project Objective: To develop an evidence-based care coordination and transitional care program that will assist patients to link with a primary care physician/practitioner,
More informationIntroduction to PCMH 2017
Introduction to PCMH 2017 PCMH 2017 Eligibility Requirements Eligibility Requirements Outpatient primary care practices Practice defined: a clinician or clinicians practicing together at a single geographic
More informationAnnual Reporting Requirements for PCMH Recognition Overview & Table Reporting Period: 4/3/ /31/2018
Annual Reporting s for PCMH Recognition Overview & Table Reporting Period: 4/3/2017 12/31/2018 Redesign Goals NCQA redesigned its PCMH Recognition program in April 2017 for practices to maintain an ongoing
More informationMIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD
MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities
More information11/7/2016. Objectives. Patient-Centered Medical Home
Team-Based Care November 10, 2016 Objectives Overview of Patient-Centered Medical Home (PCMH) Recognition Overview of PCMH Team-Based Care Discuss examples of practice teams in Montana health centers Source:
More informationAHLA. David A. DeSimone Vice President and General Counsel AtlantiCare Egg Harbor Township, NJ
AHLA HH. Achieving Patient Centered Medical Home (PCMH) and Meaningful Use (MU) Status How to Transform the Physician Practice in Light of Health Reform David A. DeSimone Vice President and General Counsel
More informationChapter 4 Health Care Management Unit 5: Quality Management
Chapter 4 Health Care Management Unit 5: Quality Management In This Unit Topic See Page Unit 5: Quality Management Quality Management Program 2 Prevention and Wellness 4 Clinical Quality 5 Network Quality
More informationPatient-centered medical homes (PCMH): Eligible providers.
ACTION: Final DATE: 09/20/2016 8:11 AM 5160-1-71 Patient-centered medical homes (PCMH): Eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationPersonalized Primary Care Annual Meeting. Care Management Catherine Hamilton, BSN, MS, MBA
Personalized Primary Care Annual Meeting Care Management Catherine Hamilton, BSN, MS, MBA Care Manager Assessments 75% of care managers assessed Observed processes Evaluated against NCQA 2014 Medical Home
More informationHealth Care Evolution
Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO
More informationCare Compact Guide Patient-Centered Specialty Care (PCSC) A Component of Medical Neighborhood Initiatives
Compact Guide Patient-Centered Specialty (PCSC) A Component of Medical Neighborhood Initiatives Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees
More informationPatient-Centered. Medical Homes (Presentation Handout)
Patient-Centered Medical Homes (Presentation Handout) Presented to AFC SPC, 3/14/13 by Barbara Schechtman, MPH 1 What is a PCMH? From the March 2007 Joint Principles of the PCMH: AAP, American Academy
More informationThe Pennsylvania Chronic Care Initiative
The Pennsylvania Chronic Care Initiative Richard L. Snyder, M.D. Senior Vice President Chief Medical Officer Independence Blue Cross William J. Warning II, M.D. Program Director Crozer-Keystone Family
More informationThe Michigan Primary Care Transformation (MiPCT) Project. PGIP Meeting Update March 09, 2012
The Michigan Primary Care Transformation (MiPCT) Project PGIP Meeting Update March 09, 2012 2 Agenda MiPCT March Launch meetings Care Management Update Performance Incentive Six Month Metrics MiPCT Quarterly
More informationTreating sinusitis? Managing obesity? Preventing heart disease? Preventing lung cancer? Managing individuals with multiple chronic diseases?
Treating sinusitis? Managing obesity? Preventing heart disease? Preventing lung cancer? Managing individuals with multiple chronic diseases? Providing care for long-term cancer survivors? Managing depression?
More informationDisclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationPatient-Centered Specialty Practice: Building the Medical Neighborhood
Patient-Centered Specialty Practice: Building the Medical Neighborhood Margaret E. O Kane President, National Committee for Quality Assurance June 6, 2014 1 Overview Central challenge: Creating systems
More informationOverview of The Joint Commission s Primary Care Medical Home (PCMH) Certification
Overview of The Joint Commission s Primary Care Medical Home (PCMH) Certification Joyce Webb, RN, MBA Project Director, Standards and Survey Methods Program Lead, The Joint Commission s PCMH Initiative
More information